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• W2014869929 abstract "Introduction: The current American Joint Committee on Cancer (AJCC) staging system for proximal cholangiocarcinoma may be inaccurate as the bile duct lacks discrete tissue boundaries. The objective of the current study was to examine the accuracy of the AJCC staging system for proximal cholangiocarcinoma. In turn, we sought to determine whether depth of tumor invasion was a more accurate predictor of prognosis in patients with resected proximal cholangiocarcinoma. Methods: Between 1987 and 2004, 297 patients who underwent surgical resection of cholangiocarcinoma were identified from a prospective, single-institution hepato-pancreato-biliary database. Of these 297 patients, 85 (27%) had a proximal cholangiocarcinoma and had pathologic slides available for re-review to measure depth of tumor invasion. Data on demographic, clinical, tumor-related and pathologic factors were collected and analyzed using univariate and multivariate models. Tumor depth was determined by measuring the distance between the basal lamina of the adjacent normal epithelium to the most deeply infiltrating tumor cells. Survival was calculated using the Kaplan-Meier estimate. Results: The mean age at surgery was 65 years and 47 patients (55%) were male. At time of operation, most patients had a bile duct resection (n=65, 76%) while 20 (24%) patients had a bile duct resection + liver resection. Most tumors were moderately-differentiated (n=46, 54%), while fewer patients had either a well- (n=20, 24%) or poorly- (n=19, 22%) differentiated tumor. On pathologic analysis, perineural invasion was present in 45 (53%) patients and vascular invasion was present in 11 (13%) patients. Invasion into the gallbladder or adjacent liver was present in 7% and 18% of patients, respectively. Thirty cases were classified as T1, 40 as T2, 15 as T3. The majority of patients (n=52, 62%) underwent an R0 resection. Overall survival was 57% at three years and 29% at five years with a median survival of 41 months. On univariate analyses, factors associated with survival included lymph node metastasis, tumor grade, and vascular invasion (all P<0.05). Of note, the current AJCC T classification was not associated with prognosis. The T classification was unable to discriminate among T1, T2, and T3 lesions (median survival: T1, 29 mos vs. T2, 19 mos vs. T3, 18 mos; P=0.20). In contrast, depth of tumor invasion was able to stratify patients with regard to long-term survival (median survival: < 5 mm, 36 mos vs. ≥ 5 mm, 17 mos; P=0.005)(Figure). On multivariate analyses tumor depth remained associated with outcome with an increased depth of tumor invasion predictive of a higher risk of disease-specific death (< 5 mm, HR=referent vs. ≥ 5 mm, HR=1.97; P=0.01). Conclusions: The current AJCC T classification for proximal cholangiocarcinoma may not accurately stratify patients with regard to prognosis. Depth of the bile duct carcinoma invasion may be a better alternative method and should be considered in the pathologic assessment of resected proximal cholangiocarcinoma." @default.
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• W2014869929 date "2010-02-01" @default.
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• W2014869929 title "Proximal Cholangiocarcinoma: Tumor Depth Predicts Outcome" @default.
• W2014869929 doi "https://doi.org/10.1016/j.jss.2009.11.422" @default.
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